Massage is a scientific remedial agent calling for specialized knowledge and much patiently acquired skill. Contrary to general opinion, it is not a modern discovery. In Oriental countries there are records of rubbing as a cure as far back as 3000 B.C., and to this day the Japanese excel in the art. It was not till the beginning of the nineteenth century, however, that massage was established on a scientific basis in Europe.
In both surgical and medical work massage is of great benefit, and to-day it is being increasingly employed in conjunction with remedial exercises and electrical methods of treatment. When prescribed for a serious injury or disease, it should invariably be left to a qualified masseur. There are, however, many minor ailments which can be benefited at home by the amateur, provided he is armed with a fair knowledge of anatomy and of the theory of the various movements.
The object of massage is to manipulate the soft tissues of the body with a view to:
- Stimulating the blood and lymph flow to bring an increased supply to the surface of the body
- Stimulating the nerve endings
- Soothing the nerves
- Improving the functions of the skin to aid the excretion of waste matter through the pores
- Breaking down adhesions
- Reducing swelling and thickening of tissues
- Improving the nutrition of all the parts by an increased blood flow
The various movements employed in the process consist of:
- Stroking or Effleurage.
- Kneading or Petrissage.
- Percussion or Tapotement.
- Passive and Active Movements.
In this movement the pressure should always be applied in the direction of the venous flow, i.e. towards the heart. The cushions of the fingers or the whole palm of the hand are placed a little below the area to be treated and a long upward curved stroke, with slight pressure, is made, the hand gliding back to the starting point without pressure. This is repeated in overlapping curves twenty to thirty times until the whole surrounding area has been covered. In the case of a limb, the joint below and the joint above the part should be included. Throughout the process the operator's hand should not be lifted from the patient's body but should continue in long rhythmical sweeps. Jerky movements are very irritating. The pressure applied should vary according to the result desired; where the object is to soothe it should be light and the movement slow; if stimulation is the aim, it should be firm and the strokes fairly swift. Effleurage usually completes a seance (session) after more vigorous movements have been applied. It acts chiefly upon the superficial blood-vessels, nerve endings, and sweat glands. In order to reach the deeper underlying tissues one has recourse to petrissage.
Petrissage is a deep movement carried out on the muscles by means of which they are picked up from the bone and rolled, squeezed and kneaded. Where the muscle is a small one, as in the hand, it is picked up between the fingers and thumb and rolled, first by the fingers against the thumb, which is kept rigid, and then by the thumb against rigid fingers. This is done four or five times and then a slight onward movement is made and the process repeated, until the whole muscle has been treated. Where the area is a large one, as on the arm or thigh, the muscle should be thoroughly grasped with the whole of both hands, the fingers should be kept steady whilst the palms and thumbs work against them in a deep upward spiral motion, gradually working up the limb, each movement overlapping the last. The hands then glide down and work slowly upwards again until the whole muscle has been thoroughly manipulated. As in eflieurage, the direction must always be towards the heart. An even motion is essential as the regular compression and relaxation urges on the blood-stream, stimulates the^nerves and empties the tissues of surplus lymph which is carried away by the deeper lymphatic vessels.
Friction consists of rubbing and kneading the muscles without picking them up from the bone. It is chiefly used around joints and where it is necessary to break down adhesions and to disperse thickened tissues. The cushions of the thumbs are placed on one spot and with out moving at all on the surface of the skin they are made to describe small circles with a fair amount of pressure, thus rubbing the underlying tissues over one another. This movement is repeated five or six times and then the thumbs are gently glided on to an adjacent part and the process repeated until the whole surface has been covered. In the case of a joint it should be completely encircled. Where it is found more practicable, the cushions of the fingers or the palms of the hands are used, for instance for the sole of the foot the latter will be found the best medium. Friction should never be used by the novice over a painful or an inflamed area, more especially around joints. It should always be followed up by effleurage to disperse any accumulated fluids.
Tapotement or percussion requires much practice to be performed effectively. A light hand and a supple wrist are absolutely essential to carry out the movement, which must be light, rapid and resilient. Where the area under treatment is a large one both hands are used to "pound" the muscle. This is done with the "ulnar" or inside edges of the lightly closed fists. Each hand strikes alternately, giving a slight outward twist from the wrist as it comes in contact with the patient's body. The movement is repeated backwards and forwards and in every direction until the whole surface has been covered. Over small or delicate parts slapping replaces pounding; this is done by rapidly striking the part with the fingers held close together, the motion coming entirely from the wrist. Hacking is another useful stroke. This is done with the open hands held slightly apart, palm to palm, and with the fingers separated and limp. Each hand strikes alternately and in doing so first the edge of the hand and then the tips of the fingers come in contact with the patient's skin producing a sharp stinging sensation which is very stimulating. Hacking is mainly performed over nerve centers.
Vibration is applied along the course of nerves. It is a sensation of trembling passed from the operator to the patient via the finger tips or the palmar surface. The finger tips lightly drawn together are placed over a nerve, the operator's hand and wrist are kept quite limp whilst the muscles of his arm and forearm are made to contract, thus producing vibrations. The movement must always be rapid and even and the progress along the nerve almost imperceptible. For the abdomen, back, or similar large surfaces the palm of the hand is applied and vibrated. This movement requires much skill and practice. It is very fatiguing for the operator and not to be recommended to the novice.
Passive and Active Movements
Passive and Active Movements are re-educative and are of great value in the after-treatment of fractures. Passive movements are so called because they are performed entirely by the operator; they are necessarily made at the joints. The left hand steadies one side of a joint whilst the right hand grasps the bone in apposition and goes through the movements of flexion, extension, abduction and circumduction, two or three times, very gently at first and then more vigorously. For instance, in the hand each phalange is manipulated separately, and when this can be borne without undue discomfort, active movements are begun, that is, the same motions are gone through by the patient entirely unaided. At a later stage resistance is given and offered. For example, the masseur places his palm against that of the patient who is encouraged to flex his wrist, the operator meanwhile holding his own wrist quite rigid. The process is then reversed, the patient offering the resistance whilst the masseur presses. The force used by the latter should, of course, be graduated and increased as the patient progresses. These movements are excellent for restoring strength and flexibility to joints which have been immobilized for a time.
Uses of Massage
The uses of massage are manifold, a few of the more common ailments with their appropriate treatment are outlined below:
Lumbago: The whole base of the back should be deeply kneaded and friction applied over the painful parts, followed up by pounding, hacking and brisk effleurage.
Sciatica: Deep kneading of the thigh and buttock, hacking over the course of the nerves, if it can be borne, followed by light effleurage.
Rheumatic Arthritis: Light friction around the joints followed by effleurage. Later passive and active movements.
Insomnia: Light effleurage over the spinal column and forehead.
Constipation: Deep kneading along the course of the colon beginning at the right-hand base of the abdomen, working upwards, transversely under the ribs, downwards on the left side, and then inwards towards the rectum. Vibrations with the palm followed by effleurage.
Obesity: Deep kneading and pounding of the tissues alternating with effleurage.
Sprains: The surrounding parts should be treated with brisk effleurage. When pain and swelling have subsided, apply light friction and effleurage to the seat of injury.
Varicose Veins: Pressure should on no account be applied over the veins; knead and stroke the surrounding tissues working always in the direction of the heart.
Fractures: When the splint is first taken off, light effleurage. Later petrissage and friction around the seat of fracture and around the joints, alternaing with effleurage. After a few days, passive movements, followed up by active and resistive exercises. If at any time the patient shows signs of undue pain or fatigue, or the temperature becomes abnormal, treatment should be suspended until a doctor is consulted.